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You are here: Contents > 2015 > Volume 24 Number 5 September 2015 > ATRIOVENTRICULAR VALVES > Force Required to Cinch the Tricuspid Annulus: An Ex-Vivo Study

Force Required to Cinch the Tricuspid Annulus: An Ex-Vivo Study

Amy Adkins1, Jesus Aleman1, Lori Boies1, Edward Sako2, Shamik Bhattacharya1

1School of Science, Engineering, and Technology, St. Mary’s University, San Antonio, 2Department of Cardiothoracic Surgery, University of Texas Health Science Center, San Antonio, Texas, USA

Background and aim of the study: Tricuspid annuloplasty is the most preferred technique for the treatment of functional tricuspid regurgitation (FTR). However, high incidences of recurrent regurgitation and risky reoperation demands a deeper insight into the technique. The cinching force required to bring a dilated annulus back to the original size is unknown. The study aim was to quantify the cinching force in the tricuspid annulus which can contribute to the long-term durability of tricuspid annuloplasty and percutaneous device design.

Methods: In ten ovine hearts, a suture was anchored around the free wall of the tricuspid annulus with the free end attached to a force transducer. The force transducer was mounted on a slider system which pulled the suture at regular intervals. Closure of the tricuspid valve was achieved by pressurizing the right ventricle at 30 mmHg through the pulmonary valve. The suture was pulled to cinch the tricuspid annulus. The tricuspid annulus area was measured

from images taken at each increment, and the corresponding force was recorded. The hearts were tested for three conditions: (i) non-pressurized (NP); (ii) pressurized (P; normal), and (iii) dilated-pressurized (DP; diseased). Leakage data were also collected for pressurized and dilated pressurized conditions. Annulus dilation was created by injecting phenol into the annulus.

Results: The maximum annulus dilation obtained was 8.82%, and the maximum cinching force was 0.38 ± 0.09 N. Leakage was increased by 81.73% from the pressurized to dilated condition.

Conclusion: The minimal force required to cinch a tricuspid annulus with severe FTR (23.98% dilation) can be approximated to 0.25 N. The required cinching force can play a major role in the long-term durability of the tricuspid annuloplasty.

The Journal of Heart Valve Disease 2015;24:644-652

Force Required to Cinch the Tricuspid Annulus: An Ex-Vivo Study

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